title: Blood pressure control in the Hypertension in the Very Elderly Trial (HYVET).
abstract: To report blood pressure control in the Hypertension in the Very Elderly Trial, a placebo-controlled trial of hypertensive (systolic blood pressure (SBP) 160-199 mm Hg, diastolic blood pressure (DBP) <110 mm Hg) participants over the age of 80 years, given treatment in three steps: indapamide slow release 1.5 mg alone, indapamide plus 2 mg perindopril and indapamide plus 4 mg perindopril. The difference in control between participants with combined systolic and diastolic hypertension (SDH, DBP90 mm Hg) and those with isolated systolic hypertension (ISH, DBP<90 mm Hg) is determined together with the effects of increments in the treatment regimen. At 2 years, the active treatment lowered blood pressure by 16.5/6.9 mm Hg more than that on placebo in participants with SDH and by 19.3/4.8 mm Hg more in those with ISH. The 2-year falls in pressure on placebo alone were 13.2/8.5 mm Hg in SDH and 8.2/1.5 mm Hg in ISH participants. With full titration of active treatment, 62% of SDH participants achieved goal SBP (<150 mm Hg) by 2 years and 71% of those with ISH. The corresponding results for DBP control (<80 mm Hg) were 40 and 78%. The addition of active perindopril 2 mg roughly doubled the percentage controlled, as did increasing to 4 from 2 mg. Blood pressure control was good with ISH and better than with SDH. The fall in SBP accounted for the observed 30% reduction in strokes, but the 21% reduction in total mortality and 64% reduction in heart failure were greater than predicted.
authors.affiliation: Imperial College London, Hammersmith Campus, Care of the Elderly, London, UK.
authors.forename: C J
authors.initials: CJ
authors.lastname: Bulpitt
authors.forename: N S
authors.initials: NS
authors.lastname: Beckett
authors.forename: R
authors.initials: R
authors.lastname: Peters
authors.forename: G
authors.initials: G
authors.lastname: Leonetti
authors.forename: V
authors.initials: V
authors.lastname: Gergova
authors.forename: R
authors.initials: R
authors.lastname: Fagard
authors.forename: L A
authors.initials: LA
authors.lastname: Burch
authors.forename: W
authors.initials: W
authors.lastname: Banya
authors.forename: A E
authors.initials: AE
authors.lastname: Fletcher
mesh_terms: D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D004359:Drug Therapy, Combination; D005260:Female; D006333:Heart Failure / Q000517:prevention & control; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007190:Indapamide / Q000627:therapeutic use; D008297:Male; D020913:Perindopril / Q000627:therapeutic use; D020521:Stroke / Q000401:mortality / Q000517:prevention & control
chemical_list: D000959:Antihypertensive Agents; D007190:Indapamide; D020913:Perindopril